Surgical retractor instrument



Jan. 4,1927.

H. E. STEIN SURGICAL RETRACTOR INSTRUMENT Filed May 26 1923 I awuemtozM1 6, azfim' 5551 7155 Qbtowm Patented Jan. 4, 1927.

UNITED STATES HERBERT E. STEIN, OF NEW YORK, N. Y.

SURGICAL RETRACTOB INSTRUMENT.

Application filed May 26,

My invention relates to improvements in surgical retractors, by meansofwhlch the lips or walls of an 1nc1s1on 1n the human body may be drawnapart and held in open 5 retracted positions during a surglcaloperation.

One or the particular objects 0t my invention is to provide a retractorwhich is practically adapted for use n any surg1cal 0p- 0 eration majoror otherwlse, and wh ch may be quickly and easily manipulated 1n placingit in operative posltlon 1n the wound, with the wound-retracting bladesheld positively in their adjusted retracting relatlon.

Another object in View is the PIOVlSlO-ll oi retracting means inaddition to the oppositely arranged retracting-blades, by vlrtue ofwhich further retraction of the wound may be obtained, at right-anglesto the retraction efi'ected by the main retractingblades. A. furtherobject of the invention 1s to provide a simple structure havingdlflerent sizes oi retracting-blades whlch may be readily brought intouse by a slight manlpulation of the parts; the larger blades beingdemountable by means of special releasable locking devices. lVith theseand other ob jects in view, my invention conslsts 1n the novelconstructions and arrangements of the several ditterent parts of theapparatus, all

as hereinafter fully described and then pointed out in the claims.

I have illustrated an embodiment of my invention in the accompanyingdrawings,

wherein;

Fig. 1, is a view in elevation of the instrument shown as placed inretracting adjustment in a wound made in a body Whichis shown inportion, the view being reduced in size compared with the remainingviews.

Fig. 2 is a view in elevation of the instrument with the large bladesmounted in place and shown in retracted positions, and with one of theblade-carrying arms shown in dotted-lines in its extreme outer limit ofadj ustment.

Fig. 3, shows a crosssectional view, the plane of the section beingindicated by line 3-3, in Fig. 2, and looking in the direction of theadjacent arrow therein.

Fig. 4, is a view slightly reduced in size,

showing how the adjustable arm is rocked on its support to adjust it.Fig. 5, is a detail view showing the two sizes of retracting-blades witha part of their 1323'. Serial No. 641,534.

arms, the View being in section on a plane indicated by line 55, in Fig.3.

Fig. 6, is a detail View showing the small retracting blades in ad ustedrelation, with the large blades removed.

- Referring to the drawings, 3 indicates a to one end of the bar andwhich if desired may be'made integral therewith, as it is preferable inan instrument of this kind to avoid unnecessary screws and joints so asto have the same free from pro ections or points.

This arrangement of the fixed arm 6, which is stationary and theadjustable arm 5, whichmay be adjusted and held at varying distancesfrom said fixed arm, provides the necessary relative adjustment betweensaid oppositely arranged members, which, as

hereinafter explained, may be provided at their ends with integral smallor large jaws or blades, or have the large blades demountably mountedover the small integral blades.

The sliding connection between the arm 5. v

and its support 3, consists in an 7, securedto thelower end of the armand fitting loosely over said bar along which it may he slid. The lowerend of arm 5, is also provided with a lateral extension 8, which runsparallel with the support 8, and in contact therewith and carries alocking pin or stud 9, having a head 10,- at its free end. This pin 9,extends into the longitudinal slot 11, formed in the support 3, with thelower edge of said slotprovided with a set of notches 12, into whichsaid pin is adapted to take. The head of the pin lies to the oppositeside of said bar from where the extension 8, is located, so that saidextension is thereby held snugly against the bar, though at the sametime has a sliding relation therewith. The adjustment of the movableblade-oarrying arm 5, is effected by grasping the arm with one lyrocking it on its sliding connection 7, thereby lifting the stud 9, outof the notch 12, in which it may be resting, and moving the stud intothe slot 11, along-which it is free to be moved over the notches anduntil the desired notch is reached, whereupon the arm is rocked backinto normal position and the stud seated in its desired notch, asindioated'in Figsul, 2 and 3. The tipped or eye or loop hand andslightrocked position of the arm to free the stud from a notch, is shownin Fig. 1, from which view it will be seen that when thus freed, theparts may be slid in either direction in order to widen or contract thespace between the arms, as the case may be. The wall of the notcheslying towards the adjustable arm 5, is slightly undercut so as to. beinclined in a direction away from said arm and this construction servesto prevent the accidental rocking of the arm on its connec tion andcausing the accidental freeing of the parts, after the adjustment of thearm has been made. It will be noted that the peculiar construction ofthe sliding and locking parts just described, provides substantially anautomatic locking means which holds the parts positively in theiradjusted positions, and that this is accomplished without the employmentof set-screws or springs.

Another important advantage resulting from this arrangement, is that anytension in an inward direction on the blade-carrying end of arm 5,serves to tilt said arm in that direction on its rocking point at 7thereby throwing downwardly the locking-stud 9, and causing the same tobe securely retained in the notch in which it is desired to keep itlocked at the time of theoperation. In this way, the effort of the woundto draw together when retracted, acts to lock the arm, inits adjustedposition, and all danger of the retractor relaxing its hold is thusavoided.

The upper ends of the respective arms 5 and 6, are provided withinwardly extend ing parts 13 and 14:, formed with the smallretracting-blades 15 and 16, projecting laterally therefrom and beingslightly hooked or bent at'the tips, where they are provided withgripping teeth 15 and 16, respectively, as more particularly shown inFigs. 5 and 6. These retracting blades are integral with the parts 13and 14:, and being comparatively small in size, are used for shallow orsuperficial incisions, for example, in the muscles.

For majorand intra abdominal operations, I provide large retractingblades 18 and 19, which is preferred may be integral with the arms,though I here show them as demountably attached over the small blades 15and 16, respectively, in the following manner. Each of the parts 13 and1 1, is

formed with a slot 20, inclined downwardly and outwardly, with a lockingdepression 21, at its inner end and a releasing opening 22, at its outerend. The attaching end of each blade or jaw 18 and 19, is provided witha headed-stud 23, the shank of which is of a size to travel easilythrough the slot 20, and to rest in the locking notch 21, but the headof the stud is of greater diameter than the width of the slot or notch21, so that the blade or jaw cannot be detached while the stud is ineither of these places. The releasing notch 22, is of a greater widththan the head of the stud 23, which may accordingly be passedtherethrough in attaching or detaching the blade. The blade is attachedby entering the stud head 23, through the enlarged notch 22', and movingthe stud along the slot 20, to the inner end thereof where it is enteredinto the locking-notch 21. This brings the blade to the rear of thesmall blade 15, with which it interlocks by means of the teeth or lugs24, 24 entering holes 25, 25, formed in the neck of the blade 18, and ashoulder 26, extending transversely oi the blade 18, and fitting againstthe hooked or bent end ot the small blade 15, as c early shown inv Figs.3 and 5. This construction locks the blade 18, firmly against the innerface of the small blade 15, and at the same time holds the blade againsta turning movement on its stud 23.

The blades or jaws 18 and 19, are constructed alike and are formed fromfiat plates bent transversely so as to curve the blades outwardly sothatthey engage the lips or walls of the incision or wound with a firm grip,the blades being made comparatively wide to present an extended surfaceor area 01. contact with the tissue so as not to mutilate the same.

A third retracting blade or jaw 27, may be mounted below the spacebetween the main blades 18 and 19, in order to cooperate with the sameand retract the wound in a direction at right angles to that of saidmain blades. This lower blade 21', is curved upon itself in a downwarddirection and the bend therein is formed concave-convex as at 28, so asto conform with the curvature in that part of the wound which itengages, as indicated in Fig. 1. The shank 29, of the blade 27, is flatand is formed with a longitudinally extending row of lockingholes 30,which are in turn engaged by a pin 31, projecting from the bottom of atransverse groove in slide 32, which is mounted to slide in thelongitudinal slot 33, in the supplemental frame 1, having upwardly bentends 2, 2, for removable attachment to the support or bar 3, by means ofthe screws 1-, 4:. The slide 32, which guided by slot 33, is held inoperative position by means of a back plate 3 1-, secured to the slideby screws 35, 35. The stem 29, of the blade 27, fits in the transversedepression in said slide, and when the pin 31, is

entered in one of the holes in the stem in adjusting the blade, thecover or latch plate 36, pivoted at 37, to the slide, is swung acrossthe stem and serves to hold it in locked position, as shown moreparticularly in Figs. 2 and 3. The piece 36, is held in closed positionby means of a small lug 38, on the slide, which snaps into a hole 39, inthe end of the piece. Thus the stem of the lower blade is adjustabletransversely of the slide and is maintained in its true position atright-angles to the bar 3. The frame 1, is suitably spaced away fromsupportng ban 3, with which it is parallel. This supplemental blade 27,when brought in service, is not put in place until the two main bladeshave been properly positioned and locked for the operation, whereuponthe blade 27, is then adjusted sons to lie substantially below thecenter of the space between the said main blades.

The main blades 18 and 19, and the smaller blades 15 and 16, with theiradjuncts, may be used without the lower blade 27, which latter may beentirely dispensed with by removing the frame 1, with its slide, screws4, 4:, being taken out for this removal.

The convenient handling of the instrument is facilitated by bowing orcurving outwarely the respective arms 5 and 6, as at 40, 41,

so that such parts serve as handles in positioning the instrument overthe inclsion and in spreading or drawing apart the retracting-blades.

From the foregoing description, the use of the instrument will bereadily understood. After an incision is made, as indicated at 42, inFig. 1, the instrument is placed in the position shown in said figure,and with the retractor blades close together so that they can beinserted in the incision and placed in engagement with the lips or wallsthereof, whereupon the blades are moved apart the desired distance toprovide the necessary retraction and furnish the opening for theoperator to work througlnas indicated in said Figure 1. In moving theblades apart, the arm 5, is tipped on its sliding connection 7, so as tobring the locking-pin 9, into the slot 11, under which condition saidarm can be moved away from its opposing arm 6, by sliding it along thebar 3. When the desired position for the arm 5, is reached, its releasalfrom the hand of the operator causes the locking-pin 9, to automaticallydrop into one of the notches 12, and securely hold the arm in saidadjustment. The instrument may be collapsed for removal by rocking thearm 5, on its sliding connection until the pin 9, is liftedfrom itsengaged notch, and then sliding the arm towards the arm 6, by reason ofthe pin 9, moving through its slot. In the operation of the instrument,it will be noted that the tendency of the wound under expansion is todraw the retracting blades together and that this action serves tofirmly hold the lockingpin of the adjustable arm, in its lockedposition.

In cases where a further retraction than that afforded by the two mainblades is required, the additional retracting-blade 27, is applied, asshown in Figs. 1, 2 and 3, and it is drawn downwardly to the desiredpoint of retraction in that direction, and then locked in saidadjustment bythe pivoted latch-piece 36.

It will be observed that in my improved instrument which providesdifferent sizes of retracting blades or jaws, that one set of the sameis integral with the device while the other set is demountable and thefacilities furnished in the way of large and small blades are broughtabout in a simple and efficient way. i j

It will be understood that the implement may be made in different sizesand the prooortions may be varied as desired and as e 7 above stated thearms may have large sized blades secured'thereto or integral therewith,instead of the small sized ones, which may then be omitted. Thesimplicity of construction and the practical absenceof projecting pointsand screw heads are also important features of my improved device. 1

I wish to be understood as not limiting my invention to the particularconstruction of the variousparts as herein shown, as it is.

evident that modifications may be made in the same, without,-however,departing from the spirit of the invention.

Having thus described my invention, what I claim and desire to secure byLetters Patent is 1. In a surgical retractor instrument, re-

tracting blades, oppositely arranged arms arms provided withretracting-blades, asupporting bar having one of said arms fixedly andthe other adjustably and slidably mounted thereon, thesaid slidingconnection comprising a guide-eye on said arm and through which said barpasses and said arm having a rocking movement with respect to said bar,locking means for retaining said sliding arm in adjusted position andcomprising a pin and rack arranged between said arm and bar, said pinand rack being engaged and disengaged with each other by the rockingmovement of said sliding arm.

3. In a surgical retractor instrument, a

pair of oppositely arranged blade-carrying members projecting inwardlytoward each other and relatively adjustable to vary the space betweenthem, each member being provided with a downwardly extending flangeprovided with an outwardly extending lockthe rocking move- 7 ing-lug andeach member having a stud-receiving slot formed therein, ar'etractor-blade adapted to be mounted on the said flange of each memberand provided at its upper end with a stud adapted to be detachablylocked with Said slot in the member, and each blade being provided witha hole for receiving the locking-lug of the flange.

4. In a surgical retractor instrument, a pair of parallel retractingarms arranged in spaced apart relation and relatively adjustable to varythe space between them, each arm being provided with a rearwardlyextending retracting blade, the adjusting means for said arms comprisinga horizontal supporting bar secured to one of said arms and providedwith a longitudinally extending series of notches, and the other armhaving a sliding connection with said supporting-bar and having a slightrocking movement thereon, and a pin carried by said sliding and rockingarm and engaging said i'i'otches to hold the arm in adjusted position,Said pin being engaged with and disengaged from said notches by therocking movement of said arm.

5. In a surgical retractor instrument, a pair of parallel retractingarms arranged opposite each other in spaced apart relation andrelatively adjustableto vary the space between them, a frame memberarranged below said arms and provided with a Slot extending atright-angles to said arms, a grooved slide mounted on' said frame memberand having a part projecting through said slot and guided in itsmovements by said slot, a siqipleinental IBtlilClOl blade provided witha stem slidably mounted in the groove on said slide on the frame membertransversely thereof and in parallel relation withsaid arms, said stembeing provided with a series oi locking-holes and a pin on said slidefor engaging said holes to adji t the position of the stem on the slideand regulate the position ot the supplemental re with respect to theblades of said retracting arms, and a pivoted retaining plate on saidSlide adapted to close over said groove to retain said stem therein.

In testimony whereof, I have hereunto set my hand.

HERBERT E. STEIN.

